How to Tailor Member Engagement for Medicare, Medicaid Populations

December 11, 2023 - Healthcare spending in the US is on a fast track. Federal actuaries expect total expenditures to reach $7.2 trillion by 2031, with Medicare and Medicaid spending projected to increase rapidly. For health plans, these spending and enrollment rates create an opportunity to optimize member engagement.

Medicare spending is expected to increase 7.8 percent per year through 2031, while Medicaid expenditures are slated to rise by an average of 5.6 percent annually during the period. In contrast, private health insurance spending is projected to grow by 5.2 percent, according to federal actuaries.

As spending grows, health plans are experiencing record enrollment rates in Medicare Advantage plans and Medicaid offerings through state programs. At the same time, rapid spending growth means plans need to focus on cost efficiency. Plans must ensure their members utilize high-quality care at the lowest cost to control spending and avoid excessive expenditures. Helping members receive preventative care can also dampen the growth rate by minimizing spending and improving outcomes.

Delivering tailored, meaningful communications to potential enrollees can increase enrollment, especially since many Medicare-eligible people avoid switching plans because of confusing processes. About half of members, including those eligible for Medicare and Medicaid, also tend to leave their Medicare Advantage plans after five years, a recent study shows. Plans can retain members through optimized member engagement for these specific populations. Research finds strong member engagement, including communication between members and health plans, can boost satisfaction levels.

“It’s important for Medicare and Medicaid plans to prevent members from voluntarily leaving, especially with Medicare Advantage. There are a lot of competitors,” emphasizes Kristen Gasteazoro, senior vice president of SmartShopper Sales and Client Performance at Zelis. “The way plans communicate with members could influence members' changing plans. When members switch plans, you lose the value of the work you’ve done year over year to understand them, manage their costs, and support their well-being.”

Effective communications — messages delivered through the most preferred medium with the most meaningful information at the appropriate time — can also drive behavior changes in members, whether plans are looking to get members to attend annual wellness visits, manage a chronic condition, or receive critical vaccinations. Guiding members also benefit the plan.

“Every year, health plans have to risk-adjust their members,” Gasteazoro explains. “CMS requires members to be charted on an annual basis to determine the premium. If plans have a high-need, high-cost population, their risk adjustment will support a larger premium to take care of those members’ health and well-being. The good news is that risk adjustment pushes everybody to get their annual wellness visit and this visit is a great way to establish member satisfaction and create a retention opportunity.” 

To capitalize on member and plan benefits, health plans need to focus on what drives engagement with Medicare and Medicaid populations. However, payers cannot simply recycle the strategies they use for employer-sponsored and other private coverage plans.

“In Medicare and Medicaid, you want to think about your targeting criteria,” Gasteazoro stresses. “What is important for the health plan to solve? Do you want to improve quality measures or member satisfaction? Or are you trying to attract new members or retain existing members as new competition enters the market? There are different strategies that come with each of those buckets.” 

Health plans need to turn to the member engagement toolbox to customize strategy according to population and objective. This means going beyond the required mailing plans must send as part of their contracts with federal and state governments.

“On average, plans send 80 to 100 pieces of mail to their Medicare members in a year,” says Gasteazoro. “That’s a lot of mail. Instead of adding more mail to the process, could they refine what the member communication calendar looks like? How can they augment their strategy with existing communications that the plan already sends?” 

The challenge with Medicare and Medicaid populations is that mail has become a default communication method because of regulations. It can be very difficult to change a Medicare member’s preferred communication method, Gasteazoro explains. However, any time a plan can convert a Medicare member, the more cost-efficient they can be.

“These communications should be dynamic and thoughtful. You don’t want to give members the option to interact with the health plan via mail and have that be it,” she states. “You always want to provide the opportunity to scan a QR code or give them the web service information to potentially participate online. They should also provide telephone numbers for telephonic service. You want to give them options because mail is the most expensive method of engaging that population.”

More older adults are comfortable using smartphones, including texting and emailing, after the COVID-19 pandemic. Many Medicaid members also have at least one phone or subsidized phone service through the government making them more connected than plans have traditionally thought.

“They’re highly digital and not mail-based considering broader access to WiFi,” Gasteazoro says. “Plans need to think about that.” 

For Medicaid populations, health plans also need a boots-on-the-ground strategy for members impacted by social determinants of health, such as housing insecurity. Plans may need to be out in the community to connect with people living in transition, for example. Plans can also address issues such as lack of transportation by tailoring benefits to overcome barriers to care access, such as offering transportation to and from appointments or pharmacies to pick up medications.

Additionally, caregivers must factor into the member engagement equation when plans serve dually eligible and/or special needs populations.

“Any strategy has to encompass caretaker engagement,” Gasteazoro explains. “There is a lot of evidence now on how caretakers have significant fatigue navigating the healthcare system. The health plan can get a lot of value from investing in these individuals because it will ultimately keep that population healthier.” 

Understanding who and how to communicate with members is key. This engagement with members and potential enrollees also needs to be purposeful. Plans need their communications to stand out from the typical mail and advertisements in the highly competitive Medicare Advantage space, but they also need their messages to relate to the member to motivate action.

Medicare and Medicaid populations, after all, tend to be older, have one or more chronic conditions, and face greater social determinants of health challenges.

Supporting a highly engaged member can be the difference between receiving a two-star rating from CMS versus a five-star rating. Getting to that level of excellence and maintaining it through member engagement can improve health outcomes, minimize spending, enhance risk adjustment, and boost marketing.

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SmartShopper Propel makes closing care gaps easy and convenient for healthcare consumers. With an omni-channel approach, Propel focuses on meeting the consumer where they are to build engagement and trust, enhancing your quality ratings. Whether focused on helping with risk adjustment or lowering total cost of care, Propel is there to meet your plan goals. To learn more contact us at SmartShopper@zelis.com or download our whitepaper.